Depressive symptoms are prevalent in older adults and may be associated with negative health outcomes. Unplanned 30-day hospital readmission is an indicator of poor patient outcomes, leads to increased healthcare costs, and has recently been targeted by the Medicare Payment Advisory Commission as a marker of poor hospital quality. The identification of patients at high risk of hospital readmission will facilitate targetng of limited discharge planning resources to those who will benefit the most and represents an opportunity for considerable cost savings to the healthcare system. Older adults are at higher risk of unplanned hospital readmission, but to date, few studies have examined the association between depressive symptoms and hospital readmission in this population. These studies have focused primarily on patients with specific illnesses or have examined different outcomes. In contrast, we will investigate the independent association between depressive symptoms and unplanned 30-day hospital readmission in adults aged 65 and older. Further, we will also examine a mechanism by which depressive symptoms may lead to hospital readmission in this patient population. The specific goals of this proposal are to determine the association between depressive symptoms and unplanned 30-day hospital readmission in a cohort of community-dwelling adults aged 65 and older, who have been admitted to a large, urban, tertiary-care hospital, and to determine the association between non- adherence to discharge instructions and both depressive symptoms and hospital readmission in this population. To achieve these objectives, we will conduct a prospective cohort study of 720 community-dwelling adults aged 65 and older who have been admitted to general medical and surgical services of the University of Maryland Medical Center . Depressive symptoms will be measured with the GDS-15 at baseline, and participants will be followed post-hospital discharge to ascertain incidence of readmission events as well as adherence to discharge instructions using survey methodology. This prospective cohort study will specifically: 1) determine the association between depressive symptoms and 30-day hospital readmission, 2) measure non-adherence to discharge instructions using an instrument created specifically for this study, 3) determine the association between depressive symptoms and non-adherence to discharge instructions and 4) determine the association between non-adherence to discharge instructions and 30-day hospital readmission. This study is novel in that it aims to address triage and admission screening procedures for older adults as well as to better elucidate the mechanisms underlying hospital readmission from a patient behavior, rather than a social or medical perspective. The public health impact of this study lies in the potential development and evaluation of interventions designed to reduce hospital readmissions by the identification and treatment of depression and depressive symptoms in the hospitalized elderly, in addition to providing information on a possible mechanism of hospital readmission. PUBLIC HEALTH RELEVANCE: Hospital readmission is a common but potentially avoidable healthcare outcome associated with considerable healthcare costs. Depressive symptoms are associated with negative health outcomes and may lead to increased hospital readmissions. The potential overall impact of this study could be changes in screening procedures for older adults as well as reductions in hospital readmission by early identification and treatment of depression in these individuals.